DESCRIPTION (Taken from application abstract): Recent trends in health care delivery have led to an increased emphasis on the development of guidelines for prevention, diagnostic workup, treatment, and patient-management processes (clinical pathways). Such guidelines are motivated by concerns about marked variations in clinical practice and are designed to help provide a common standard of care both within a health care organization and among different organizations. The goal of the proposed research is to develop tools and techniques to promote the computerization of guidelines by developing a standard to represent them, an Internet server to store and execute them, mechanisms for translation into a local execution environment, and finally use in conjunction with computer-based medical record systems. This proposal includes researchers from five academic medical centers and the American College of Physicians (ACP) to build and test the generality of these approaches to the creation, distribution, and use of clinical guidelines. Together, we will pursue the following five specific aims: 1) To create a guideline server (accessible over the Internet) that can provide support for distributing and sharing encoded versions of guidelines developed b), federal agencies such as the AHCPR and medical organizations such as the ACP. The server will allow visitors to perform five activities: a) to browse the encoded guidelines using a web-based version of the guideline creation and viewing tools; b) to access both the original textual versions of the documents and descriptions of assumptions about the intended scope of the guidelines; c) to request server-based computation of eligibility for guidelines and execution of some categories of protocols; d) to download guideline descriptions in GLIF format for local custom tailoring and implementation; and e) to request information about other individuals or organizations which are utilizing the same guidelines; 2) To examine, characterize, and encode representative guidelines at each of the four sites. For our testbed, we will use a subset of the ACP-developed guidelines augmented by guidelines created by other federal or medical organizations; 3) To continue our current research efforts in the representation of guidelines to support alms I and 2; 4) To put the guidelines into operation at Columbia and Massachusetts General Hospital, after each organization has obtained the appropriate institutional approvals for clinical use and to assess how the guidelines are used at these two clinical sites; and 5) To study cognitive aspects of creating guidelines, of the encoding tasks described above, and of the clinical use of guidelines in computer assisted environments.